cardiac Flashcards
1
Q
systolic BP
A
highest pressure achieved by the contraction of the L ventricle
2
Q
diastolic BP
A
BP maintained in aorta between ejections
3
Q
pulse pressure
A
difference between SBP and DBP
4
Q
baroreceptors
A
send signals to brain when there are changes in BP
5
Q
If there is a change in BP, what happens to the cardiovascular center?
A
HR increases and it vasoconstricts to increase blood flow to the heart
6
Q
Neural and Humoral mechanisms are responsible for what type of regulation of BP? what about Renal mechanisms?
A
Short term, neural: SNS and PNS Humoral: RAA, ADH
renal: long term
7
Q
stage 1 HTN SBP
A
140-159
8
Q
stage 2 HTN SBP
A
> 160
9
Q
what is the role of the sympathetic nervous system?
A
increases contractility and heart rate, induces anteriolar vasoconstriction, contributes to structural remodeling of blood vessels, renal and NA retention
10
Q
what is the Renin-angiotensin-aldostrone system?
A
liver produces angiotensinogen which acts on kidneys which produce rennin which makes Agiotensin 1 which goes to lungs which produce ace which makes angiotensin 2 which act on adrenal glands which make aldosterone which increases NA absorption which increases BP, this also causes vasoconstriction in arterioles
11
Q
Primary HTN
A
HTN d/t elevation in BP that is not the result of another disease process
12
Q
Secondary HTN
A
HTN resulting from another disorder ex. kidney disease, pregnancy
13
Q
malignant HTN
A
accelerated form of HTN DBP >120, medical emergency!
you can get cerebral edema and otic nerve swelling, H/A
14
Q
Isolated Systolic HTN (ISH)
A
hypertension in elderly d/t stiffened arteries
15
Q
Oslers maneuver
A
compress radial artery and if artery is palpable then its not true HTN, its pseudohypertension because arteries are stiff
16
Q
Target Organ Disease (TOD)
A
increased workload of L ventricle which leads to heart failure, atherosclerosis develops, decreased GFR of kidneys leads to nocturia, proteninuria
17
Q
what causes Orthostatic Hypotension
A
decrease in venous return, decreased cardiac output
18
Q
conditions that cause orthostatic hypotention
A
dehydration, bed rest, spinal cord injury, vomiting, diarrhea, medications, autonomic nervous system disorders, aging
19
Q
Atherosclerosis
A
hardening of arteries, lesions in arteries
20
Q
fatty streaks, what is it made up of
A
common in all ages, contains foam cells of smooth muscle, thin, yellow that progressively enlarge
21
Q
Fibrous Plaques, what is it made up of and what does it do
A
connective tissue, progressively thickens and occludes lumen
22
Q
Complicated lesion, what is it made up of and what does it do
A
fibrous plaque thats soft that can rupture, contains ulcers that can crack and bleed and the forms a clot!
23
Q
common sites for atherosclerotic lesion
A
abdominal aorta and iliac arteries, carotid arteries, thoracic aorta, femoral, popliteal arteries, coronary arteries
24
Q
Artherosclerotic lesions: Fixed or stable plaque
A
obstructs blood flow and is implicated in stable angina
25
Artherosclerotic lesions: unstable or vulnerable plaque
can rupture, cause thrombus formation and is implicated in unstable angina and MI
26
what determines the vulnerability of plaque in atherosclerosis to rupture?
size, thickness, inflammation, lack of smooth muscle with impaired healing, thin fibrous cap
27
CAD risk factors
low birth weight, obesity, HTN, hyperlipidemia, smoking, family Hx, men >45, women >55
28
Hyperlipidema risk factors
cholesterol >200, dietary, genetic,alcoholism, hypothyroidism, corticosteriods, estrogens
29
Homocysteine
promotes progression of atherosclerosis by causing endothelial damage and increases LDL and smooth muscle growth
30
who should be screened for high levels of Homocysteine?
unusual family hx, poor nutritional status, unexplained atherosclerosis deposits
31
major complications of atherosclerosis
Ischemic heart disease, Stroke, PVD
32
Coronary heart disease: Chronic Ischemic heart disease
chronic stable angina, silent heart ischemia and varient vasospastic angina
33
Coronary heart disease: Acute coronary syndrome
NSTEMI, STEMI
34
Coronary Artery Disease
narrowing of the coronary arteries d/t atherosclerosis
35
Coronary Artery disease affect on the heart and what does it lead to
it blocks the oxygen supply to heart tissue which leads to HTN, angina, hysrhythmias, MIs, CHF
36
Collateral circulation
growing new vessels to supply organs
37
what do you see on an EKG with CAD with ischemia? during MI?
ischemia: ST or T wave depression
MI: ST elevation, T wave depression
38
which hour are you hypercoagulable which leads to the most MIs?
6am
39
#1 Sudden cardiac death cause
because of lethal dysrhythmias
40
unstable angina and causes
recent onset, change in pattern
| causes: atherosclerotic plaque disruption, platelet aggregation, secondary hemostasis
41
stable angina and causes
constant pattern of pain and severity
| causes: coronary stenosis
42
Variant (Printzmetals angina) and causes
rest pain and V-arrhythmias cause by carotid artery spasm,
| causes: drug abusers, coronary vasospasm
43
Angina heart sounds
split S2 on expiration, S4, S3, systolic murmur
44
how many days until granulation tissue forms after an AMI?
8-10 days
45
how long after an AMI does infarct turn gray with yellow streaks?
48 hrs
46
how long after an AMI does necrotic area develop into a scar?
2-3 months
47
the size of an AMI depends on what?
extent, severity, duration, amount of collateral circulation, metabolic needs of the heart at the time of the event
48
anterior or septal MI occurs when which artery is obstructed?
left anterior artery (LAD)
49
lateral wall MI occurs when which artery is obstructed?
circumflex artery
50
Inferior/posterior wall MI occurs when which artery is obstructed?
right coronary artery (RCA)
51
Subendocardial infarcts, what does it involve and when does it occur
involve 1/2 of ventricular wall, occur when arteries are narrow but patent
52
Transmural infarcts, what does it involve and when does it occur
involve full thickness of ventricular wall, occur when there is obstruction of a single artery
53
does myocardial regenerate?
NO, damaged tissue is replaced by scar tissue
54
1 mm ST segment elevation in 2 contiguous leads is indicative of what?
AMI
55
Creatinine Phosphokinase (CPK), where is it found?
CK-MM
CK-MB
CK-BB
enzyme found in heart (MB), brain(MM) and skeletal muscle(BB)
56
LDH1 and LDH 2
enzymes used to detect heart damage
57
Diagnostic gold standard to detect MI
Troponin 1
58
Thallium Scans
assess ischemia or necrotic muscle tissue
59
MUGA scans
to evaluate L ventricular function
60
what kind of rub do you hear with ischemic pericarditis
pericardial friction rub
61
cardiac output
amount of blood the heart pumps each minute (L/min)
62
what does the sympathetic nervous do to the heart rate
increases it
63
what does the parasympathetic nervous do to the heart rate
decreases it
64
stroke volume
amount of blood the heart pumps with each beat
65
cardiac reserve
maximum percentage of increase in cardiac output achieved above normal resting level
66
aortic impedence
loss of elasticity of aortic wall (this increases with aging)
67
what happens to the left ventricle with aortic impedance?
the left ventricle must generate higher pressure to get blood through
68
starlings law
the degree to which the heart muscle can stretch
69
preload
volume of blood the heart pumps out
70
after load
the pressure it must generate to pump the blood out of the heart
71
myocardial contractility and its most important factor in what?
force of contraction
important factor: ventricular performance!!
72
what happens to the heart according to starlings law with heart failure?
there is an increase in muscle stretch but no increase in force of contraction, (a floppy muscle)
73
heart compliance
the ease with which the heart relaxes as it fills with blood
74
what will an echo look like with a patient who has systolic heart failure?
it will have a floppy muscle
75
How do we prevent the heart muscle from becoming floppy with systolic heart failure?
lower the BP
76
aortic stenosis and HTN effect on after load
it increases it
77
what does an increased after load do to the heart?
It increases the workload and oxygen consumption
78
if myocardial contractility is increased, what happens to amount of blood that is ejected?
its increased
79
if myocardial contractility is increased, what happens to the systolic ejection fraction?
it increases
80
if myocardial contractility is increased, what happens to the end systolic volume?
it decreases
81
if myocardial contractility is decreased, what happens to amount of blood that is ejected?
it decreases
82
if myocardial contractility is decreased, what happens to the systolic ejection fraction?
it decreases
83
if myocardial contractility is decreased, what happens to the end systolic volume?
it increases
84
what is dependent on the concentration of catecholamines in the heart muscle
myocardial contractility
85
what is the myocardial contractility influenced by?
preload, after load and SNS stimulation
86
negative inotropic effects on the heart (3) and what do they do to it?
hypoxemia of the heart, hypercapnia of the heart, academia (acidosis) of the heart------IT DEPRESSES THE HEART so it can't work!
87
inotropic
agent that affects the heart speed of force of contraction
88
which stretches more easily and which works under pressure? veins or arteries
veins: stretch
Arteries: work under pressure
89
stroke volume
amount of blood ejected with each ventricular contraction
90
End-diastolic volume
total volume in L ventricle at end of filling just prior to contraction
91
End-systolic volume
total volume in L ventricle at the end of the contraction
92
EF
percent volume of blood ejected with each ventricle contraction
93
#1 cause of heart failure
atherosclerosis
94
Ischemic heart disease (CAD), AMI, cardiomyopathy, myocarditis, constrictive pericarditis, congenital heart defects are all causes of what kind of heart failure
Intrinsic
95
COPD, pulmonary embolism, hyperthyroidism, HTN, AV fistulas, drug toxicities are all causes of what kind of heart failure?
secondary
96
With heart failure there is a decrease in cardiac output, what compensatory responses do you get with this?
SNS increases HR, kidneys release HR to increase BP, anaerobic metabolism and increased oxygen extraction by peripheral cells
97
what happens to heart muscle with systolic heart failure
L ventricular muscle is stretched out and floppy
98
what happens to heart muscle with diastolic heart failure?
muscle hypertrophy (heart muscle is bigger causing a decrease in L ventricular chamber size)
99
high out put heart failure is which kind of heart failure?
diastolic heart failure
100
low out put heart failure is which kind heart failure?
systolic heart failure
101
whats the treatment for low output heart failure or systolic heart failure?
diuretics
102
Left sided heart failure represents?
failure of the left side of the heart to move blood from the lungs to the circulatory system
103
causes of left sided heart failure
AMI, systemic HTN, cardiomyopathy, aortic stenosis
104
Because blood backs up into lungs with left sided heart failure, (backward effect) what can you get from this?
pulmonary edema
105
because blood is not going to the circulatory system with left sided heart failure (forward effect), what compensatory mechanism kick in?
SV decreases and RAA and SNS kick in to try and get HR and BP up which makes the heart failure worse!
106
why does SOB and cyanosis occur with pulmonary edema?
because lungs are not able to oxygenate the blood so the blood leaves the lungs without being oxygenated
107
Right sided heart failure represents?
failure of the right side of the heart to move blood from the circulatory system to the lungs
108
because right sided heart failure isn't able to pump blood to lungs, what do you get from this?
it causes peripheral edema and congestion of abdominal organs
109
#1 major cause of right sided heart failure?
left ventricular failure d/t excessive pressures in the pulmonary capillary bed
110
besides left ventricular failure as the major cause of right sided heart failure, what are other causes of right sided heart failure?
cor pulmonale, COPD, PE, valve disease, Right coronary artery infarct, cardiomyopathy
111
what major organ is affected with R sided heart failure? and what do you get because of it?
the Liver which causes ascites
112
s/s right sided HF
JVD, plural effusions, hepatomegaly, hypoalbuminemia, resp symptoms only if have lung disease, dependent edema after first 10 lbs gain
113
Biventricular heart failure
L to R heart failure
right doesn't cause left but left can cause right
114
causes of systolic heart failure
AMI, CAD, valve disease
115
causes of diastolic heart disease
HTN, COPD, pulmonary HTN, aortic stenosis, pulmonic stenosis
116
class 1 heart disease
patients don't have any limitations in physical activity
117
class 2 heart disease
patients have slight limitations of physical activity
118
class 3 heart disease
patients have marked limitation of physical activity
119
class 4 heart disease
patients have unable to carry out physical activity without discomfort
120
congestive cardiomyopathy
associated with hyperthyriodism, alcoholism, childbirth
121
restrictive cardiomyopathy
heart becomes infiltrated with abnormal substances causing extensive fibrosis
122
hypertrophic cardiomyopathy
hypertrophy of septum which causes an obstruction of outflow of blood
123
myocarditis cardiomyopathy
infection from viruses, inflammation from chemo
124
Chords tendinae
connect valve leaflets to muscles, help keep leaflets closed under pressure
125
papillary muscle
extension of the heart muscle that pull valves together to prevent back flow
126
valvular heart disease
occurs when heart valves can't fully open or close
127
grade 1 murmur
soft, heard only under quiet conditions
128
grade 2 murmur
soft, heard under even noises conditions
129
grade 3 murmur
easily heard, prominent
130
grade 4 murmur
loud, associated with a thrill
131
grade 5 murmur
loud, with stethoscope tilted against chest with thrill
132
grade 6 murmur
very loud with thrill
133
diastolic murmurs are only graded to?
grade 4
